Fatal Form of COVID-19 in a Young Male Bodybuilder Anabolic Steroid Using: The First Autopsied Case

Figures

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  Figure 1. Macroscopic autopsy findings: (A,B)—Marked muscular hypertrophy; (C)—violet pulmonary surface, with multiple reddish hematic suffusions (microhemorrhages); (D)—pulmonary section, dark red blood, and foamy, pinkish fluid oozes. (E)—atherosclerosis of the descending aorta; (F)—heart hypertrophy (LV—left ventricle); (G)—transversal serial sections through the heart, with the highlighting of the old infarction; (H)—hepatic dystrophy; (I)—hepatic section; (J)—pancreas hypertrophy.

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  Figure 2. Results of the histopathological examination, HE: (A)—microthrombi with endothelitis (arrows) in cerebral tissue, on cerebral edema background; (B)—stasis, emphysema and massive pulmonary edema with DAD grade 1 (detail arrows); (C)—focal organizing pneumonia (arrow) and alveolar giant macrophages with nuclear viral inclusion (arrow head); (D)—pulmonary thromboembolism (arrow); (E)—hypertrophic myocadiac muscular fibers; (F)—old subendocardial myocardial infarction (arrows), associated with significant coronary artery occlusion by advanced atheromatous plaque (insert); (G)—hepatic peliosis (arrows); (H)—severe pancreatic nesidioblastosis and pancreatic multifocal necrosis (arrow).

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  Figure 3. Results of the immunohistochemical examinations: (A)—ACE-2 focal positive on the endothelium of intramyocardial vessels (×400); (B)—SARS-CoV-2 focally positive on the endothelium of intramyocardial vessels (×400); (C)—ACE-2 intensely positive on the proximal tubules and corresponding arteriole of the juxtaglomerular apparatus (×400); (D)—SARS-CoV-2 focally positive on intertubular capillaries (×400); (E)—ACE-2 intensely positive on the beta cells of the islets of Langerhans (×200); (F)—SARS-CoV-2 focally positive on the beta cells of the islets of Langerhans (×400); (G)—ACE-2 positive on the endothelium of pulmonary vessels (×400); (H)—ACE-2 positive on lymphocytes from splenic follicles (×400); (I)—SARS-CoV-2 positive on alveolocytes (×400).